The debate surrounding the Patient Protection and Affordable Care Act illustrates the impoverishment of our political life. Here is a law that had its origin in the right-wing Heritage Foundation, was first put into practice in 2006 in Massachusetts by then-Gov. Mitt Romney and was solidified into federal law after corporate lobbyists wrote legislation with more than 2,000 pages. It is a law that forces American citizens to buy a deeply defective product from private insurance companies. It is a law that is the equivalent of the bank bailout bill—some $447 billion in subsidies for insurance interests alone—for the pharmaceutical and insurance industries. It is a law that is unconstitutional. And it is a law by which President Barack Obama, and his corporate backers, extinguished the possibilities of both the public option and Medicare for all Americans. There is no substantial difference between Obamacare and Romneycare. There is no substantial difference between Obama and Romney. They are abject servants of the corporate state. And if you vote for one you vote for the other.

But you would never know this by listening to the Democratic Party and the advocacy groups that purport to support universal health care but seem more intent on re-electing Obama. It is the very sad legacy of the liberal class that it proves in election cycle after election cycle that it espouses moral and political positions it will not pay a price to defend. And since we have no fight in us, since we will not punish politicians like Obama who betray our core beliefs, the corporate juggernaut rolls forward with its inexorable pace to cement into place our global neofeudalism.

Protesting outside the Supreme Court recently as it heard arguments on the constitutionality of the Affordable Care Act were both conservatives from Americans for Prosperity who denounced the president as a socialist and demonstrators from Democratic front groups such as the SEIU and the Families USA health care consumer group who chanted “Protect the law!” Lost between these two factions were a few stalwarts who hold quite different views, including public health care advocates Dr. Margaret Flowers, Dr. Carol Paris and attorneys Oliver Hall, Kevin Zeese and Russell Mokhiber. They displayed a banner that read: “Single Payer Now! Strike Down the Obama Mandate!” They, at least, have not relinquished the demand for single payer health care for all Americans. And I throw my lot in with these renegades, dismissed, no doubt, as cranks or dreamers or impractical by those who flee into the embrace of empty political theater and junk politics. These single payer advocates, joined by 50 doctors, filed a brief to the court that challenges, in the name of universal health care, the individual mandate.

“We have the solution, we have the resources and we have the money to provide lifelong, comprehensive, high-quality health care to every person,” Dr. Flowers said when we spoke a few days ago in Washington, D.C. Many Americans have not accepted the single payer approach “because people get confused by the politics,” she said. “People accept the Democratic argument that this [Obamacare] is all we can have or this is something we can build on.”

“If you are trying to meet the goal of universal health coverage and the only way to meet that goal is to force people to purchase private insurance, then you might consider that it is constitutional,” Flowers said. “Our argument is that the individual mandate does not meet the goal of universality. When you attempt to use the individual mandate and expansion of Medicaid for coverage, only about half of the uninsured gain coverage. This is what we have seen in Massachusetts. We do, however, have systems in the United States that could meet the goal of universality. That would be either a Veterans Administration type system, which is a socialized system run by the government, or a Medicare type system, a single payer, publicly financed health care system. If the U.S. Congress had considered an evidence-based approach to health reform instead of writing a bill that funnels more wealth to insurance companies that deny and restrict care, it would have been a no-brainer to adopt a single payer health system much like our own Medicare. We are already spending enough on health care in this country to provide high-quality, universal, comprehensive, lifelong health care. All the data point to a single payer system as the only way to accomplish this and control health care costs.”

Obamacare will, according to figures compiled by Physicians for a National Health Plan (PNHP), leave at least 23 million people without insurance, a figure that translates into an estimated 23,000 unnecessary deaths a year among people who cannot afford care. Costs will continue to climb. There are no caps on premiums, including for people with “pre-existing conditions.” The elderly can be charged three times the rates provided to the young. Companies with predominantly female workforces can be charged higher gender-based rates. Most of us will soon be paying about 10 percent of our annual incomes to buy commercial health insurance, although this coverage will pay for only about 70 percent of our medical expenses. And those of us who become seriously ill, lose our incomes and cannot pay the skyrocketing premiums are likely to be denied coverage. The dizzying array of loopholes in the law—written in by insurance and pharmaceutical lobbyists—means, in essence, that the healthy will receive insurance while the sick and chronically ill will be priced out of the market.

Medical bills already lead to 62 percent of personal bankruptcies, and nearly 80 percent of those declaring personal bankruptcy because of medical costs had insurance. The U.S. spends twice as much per capita on health care as other industrialized nations, $8,160. Private insurance bureaucracy and paperwork consume 31 percent of every health care dollar. Streamlining payment through a single, nonprofit payer would save more than $400 billion per year, enough, the PNHP estimates, to provide comprehensive, high-quality coverage for all Americans.

But as long as corporations determine policy, as long as they can use their money to determine who gets elected and what legislation gets passed, we remain hostages. It matters little in our corporate state that nearly two-thirds of the public wants single payer and that it is backed by 59 percent of doctors. Public debates on the Obama health care reform, controlled by corporate dollars, ruthlessly silence those who support single payer. The Senate Finance Committee, chaired by Max Baucus, a politician who gets more than 80 percent of his campaign contributions from outside his home state of Montana, locked out of the Affordable Care Act hearing a number of public health care advocates including Dr. Flowers and Dr. Paris; the two physicians and six other activists were arrested and taken away. Baucus had invited 41 people to testify. None backed single payer. Those who testified included contributors who had given a total of more than $3 million to committee members for their political campaigns.

“It is not necessary to force Americans to buy private health insurance to achieve universal coverage,” said Russell Mokhiber of Single Payer Action. “There is a proven alternative that Congress didn’t seriously consider, and that alternative is a single payer national health insurance system. Congress could have taken seriously evidence presented by these single payer medical doctors that a single payer system is the only way to both control costs and cover everyone.”